Provider Demographics
NPI:1144976192
Name:JOHNSON, AMBER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PRIVATE ROAD 1279
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:TX
Mailing Address - Zip Code:76671-3005
Mailing Address - Country:US
Mailing Address - Phone:903-360-3507
Mailing Address - Fax:
Practice Address - Street 1:11300 N CENTRAL EXPY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6712
Practice Address - Country:US
Practice Address - Phone:903-360-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical